Infection Control Today

MAY 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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" Any time you break the skin, you're breaking down the body's frst line of defense against infection. — James Davis, MSN, RN, CCRN-K, HEM, CIC, FAPIC " Not very long ago, expertly stafed IV teams were common, but many hospitals now perceive these teams as an unnecessary luxury. — William M. Marella, MBA, MMI 12 ICT May 2019 www.infectioncontroltoday.com Early Recognition of Sepsis Across the Continuum Sepsis can be diffcult to detect, but early recognition is vital because sepsis can quickly turn deadly. "We're in a time rush," says James Davis, MSN, RN, CCRN-K, HEM, CIC, FAPIC, senior infection prevention and patient safety analyst/consultant, ECRI Institute. The challenge is, "Can we intervene quicker to get patients the care they need to prevent shock and death?" Davis adds. In recent years, sepsis has gained attention in acute- care. But as healthcare delivery changes, "we're moving that early recognition of sepsis outside the hospital" as much as possible, says Davis. Timely screening and recognition of sepsis is a challenge for other settings as well, including aging services and physician practices. Healthcare workers throughout the continuum of care must be able to recognize sepsis. "IPs have mixed involvement in sepsis prevention programs," Marella says, but an IP could make a significant contribution to sepsis management, particularly with respect to evaluating how long invasive medical devices are used in treating the patient and removing them as early as possible. Outside the hospital, a physician practice or aging services provider doesn't likely have an IP, but there should be someone there who is the owner of the sepsis recognition protocol. In these settings, it's all about early recognition and transferring the patient to an appropriate level of care. As healthcare systems are consolidating and acquiring physician practices and long-term care sites, IPs have an opportunity to raise awareness, and educate staff in these settings on recognition and quick response." The ECRI Institute report adds that healthcare personnel such as certifed nursing assistants can be trained to use screening tools, and physician practices can screen for sepsis both in the exam room and on the phone. Simulation and skills practice can help workers recognize sepsis and communicate their concerns. To facilitate timely diagnosis and management, the ECRI Institute report says that "healthcare organi- zations across the continuum should have protocols for response when sepsis is suspected, much as they do for chest pain. Organizations may use checklists, tools, or algorithms to support the response. Another key is sharing information across the continuum. For example, knowing that an individual normally has only mild confusion can help providers suspect sepsis when that person seems very confused. Settings across the continuum can also identify opportunities for collaboration. Because hospital readmissions are concerns for both hospitals and nursing facilities, they may collaborate to address problems—for example, by ensuring safe discharge, communicating necessary information, sharing strategies, and establishing a consultation system." "Foster that cooperative behavior," advises Davis. "Are there things we can do to help each other out?" Infections from Peripherally Inserted IV Lines Peripheral intravenous (PIV) catheters are commonly used items in healthcare. Often, PIVs are inserted upon admission as a matter of course, in case the patient needs IV therapy at a later point. However, PIVs can expose patients to a signifcant risk of infection—one that is underreported, underrecognized, and often ignored, according to Davis. "Any time you break the skin, you're breaking down the body's frst line of defense against infection," says Davis. "Patients might not need a peripheral line, but your staff might put one in just because the patient is admitted and they may need it at some point. Staff may say, 'Well, it's only going to be in for an hour or two,' not realizing that that's enough time for an infection to develop." Tracing infections back to the PIV line can be diffcult, according to Davis, because healthcare workers tend to overestimate their safety. "If a patient gets both a peripheral line and a central line and later develops a bloodstream infection, clinicians will often attribute it to the central line without even considering the PIV line," says Davis. Increased awareness of PIV-catheter-related infections, coupled with routine active surveillance and follow-up reporting, can help reduce the risk. "Staff need to understand that it can happen, and that it can be serious," says Davis. Staff should also slow down and assess whether a patient actually needs a PIV catheter inserted. "Staff need to respect putting in that PIV catheter, so that they slow down and treat it with the same reverence as if they were making an incision," says Davis. "It is a thoughtful process." "Not very long ago, expertly staffed IV teams were common, but many hospitals now perceive these teams as an unnecessary luxury, Marella emphasizes. "In the absence of this, it becomes more important to have good processes for developing the skills of new nurses, particularly in how they cope with patients who are diffcult to gain IV access or when a patient's existing lines are failing. It would also help to make more consistent decisions about when to place lines, which lines to use in different applications, and how long to leave them in. The latter is easily accomplished by reinstating IV teams that work in conjunction with the IP and other disciplines." Marella continues, "On surveillance, IPs should be surveilling not only for infections but also the precursors to infection, such as patients whose lines have been left in too long, and similar things like placement location or dressing integrity, that increase risk of a bloodstream infection. They can also do general surveillance for proper care and maintenance of IV lines, dressings, and phlebitis. It's also important to feed fndings of this kind of surveillance back to management and staff to foster improvement. The IP should not be alone in these efforts. It is important to have a team approach to surveillance. IV teams for example can show value by performing surveillance, just in time education, in-services, and other activities that prove worth, increase patient and nursing satisfaction, all the while preventing infections." Reference: ECRI Institute. 2019 Top 10 Patient Safety Concerns Executive Brief. Available at: https://www.ecri.org/landing-top-10-patient- safety-concerns-2019.

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